Higher prevalence of colon polyps in patients with Barrett's esophagus: a case-control study.

BACKGROUND AND AIMS: Barrett's esophagus (BE) and colorectal neoplasms share similar risk factors. Previous studies have shown variable prevalence of colon polyps in patients with BE. Our aims were to determine the prevalence and incidence of colon polyps in patients with BE, compared to those without BE. METHODS: In this case-control study, the study group included patients, aged 50-75 years, with biopsy-proven BE, who underwent colonoscopy at Cleveland Clinic from January 2002 to December 2011. The control group consisted of age- and sex-matched patients who underwent colonoscopy and also an endoscopy with no evidence of BE during the same time period. Exclusion criteria for both groups were family- or personal previous history of colon cancer or polyps, prior colonic resection, inflammatory bowel disease and familial polyposis syndromes. Patient demographics, comorbidities, medication use and endoscopic and colonoscopic details were collected, including biopsy results. RESULTS: A total of 519 patients were included in the study; 173 patients with BE in the study group and 346 without BE in the control group. Mean age at index colonoscopy was 61 ± 8 years and 75% of patients were male. On index colonoscopy, patients with BE were more likely to have polyps than controls (45% vs 32%, respectively; P = 0.003). Patients underwent between one and five colonoscopies during the follow-up. On multivariate analysis-after adjusting for age, gender and diabetes-patients with BE were 80% more likely to have any type of polyp, and 50% more likely to have adenomas found during colonoscopy. CONCLUSIONS: Patients with BE had higher prevalence and incidence of colon polyps. This has important clinical implications for screening and surveillance in BE patients.

Relationship between type-2 diabetes and use of metformin with risk of colorectal adenoma in an American population receiving colonoscopy.

The aim of this study is to explore the relationship between type-2 diabetes, its treatments (Use of metformin) and the development of colorectal adenoma. Colonoscopy reports from a total of 66 endoscopists in one big hospital in midwest during 2008-2009 were reviewed. Colonoscopy findings including quality of preparation, polyp size, location, morphology, pathology and history of diabetes and metformin treatment were retrieved. Of the 7382 colonoscopy reports were reviewed, 3465 average risk patients were included in our final analysis. The pathologically proven Adenoma detection rate (ADR) in total population was 24.6 % (30.2% in Men and 19.2% in Women). Old age and male sex were significantly associated with increasing risk of colorectal adenoma. Type-2 diabetes was associated increased risk of colorectal adenoma (OD 1.35, 95% confidence interval 1.08-1.70, p=0.009). A total of 426 subjects (12.29%) had diabetes and 405 of these subjects (11.7%) had type-2 diabetes. Within diabetic patient group, people who were taking metformin have significantly lower risk of colorectal adenoma (OD 0.55, 95% confidence interval 0.34-0.87, p=0.011). Diabetic subjects have increased risk of developing colorectal adenoma. Our study also supports the beneficial effect of metformin in development of colorectal adenoma.

Use of and attitudes toward complementary and alternative medicine among osteopathic medical students.

CONTEXT: Complementary and alternative medicine (CAM) has grown into a huge health care industry in the United States, with 91.5 million people (38% of adults) using CAM in 2007. Given the increase in CAM use and the need for CAM education for health professionals, it is important to understand the baseline attitudes and beliefs of osteopathic medical students regarding CAM, as well as the factors that may have formed them. OBJECTIVES: (1) To determine osteopathic medical students' use of different CAM modalities. (2) To assess osteopathic medical students' attitudes toward CAM using a previously validated instrument. METHODS: A previously validated, 29-item Integrative Medicine Attitude Questionnaire and a 10-item CAM Health Belief Questionnaire were administered to osteopathic medical students. Demographic and other data were collected on student use of and recommendations for CAM modalities as well as student awareness and use of primary CAM information resources. RESULTS: Survey respondents were 635 osteopathic medical students from 7 osteopathic medical schools and additional locations in the United States. Osteopathic medical students demonstrated positive attitudes toward CAM use. A total of 527 osteopathic medical students (83.0%) self-reported the use of at least 1 CAM modality, whereas 69 students (10.9%) used just 1 CAM modality and 458 (72.1%) used 2 or more modalities. The most commonly used CAM modalities--meditation/yoga/relaxation/imagery, massage, and spirituality/prayer--were also most likely to be suggested to patients by osteopathic medical students. Sex, age, and the use of CAM modalities were significantly correlated with attitudes toward CAM modalities. CONCLUSION: Osteopathic medical students had a positive attitude toward CAM and had high levels of self-reported CAM knowledge and use. Osteopathic medical students who acquire professional training and have personal experience with CAM may be in a better position to discuss CAM with future patients.

Prasugrel as a safe alternative for clopidogrel-associated arthritis.

Clopidogrel is a thienopyridine derivative antiplatelet compound. The antiplatelet effects of clopidogrel originate through noncompetitive antagonism of the platelet ADP receptor, P2Y12, resulting in inhibition of platelet activation. Clopidogrel is now widely used in acute coronary syndromes and after percutaneous coronary interventions to reduce the risk of subsequent cardiovascular events. We report a case of acute migratory polyarthritis associated with the use of clopidogrel. This serves as only the second documented case of clopidogrel-associated arthritis in the United States, and the first to show that prasugrel may be considered as an alternative agent without short-term reoccurrence.

Preventive behaviors, beliefs, and anxieties in relation to the swine flu outbreak among college students aged 18-24 years.

AIM: The objective of this study was to assess beliefs, misconception, and anxiety in relation to swine flu outbreak and whether perception of the outbreak predicted changes in behavior. SUBJECT AND METHODS: In November 2009, we conducted an Internet-based cross-sectional survey of college students aged 18-24 years in a Midwestern State in the USA. We collected information on swine flu knowledge, perception on immunization safety, perceived efficacy of recommended behavior, changed behavior, and anxiety. RESULTS: Of the 236 respondents, 83.1% had some anxiety about swine flu, 64.8% believed avoiding crowded places was preventive, 33.5% believed the 2009 swine flu vaccine was safe, and 36.9% showed interest in receiving the vaccine. Misconceptions about swine flu contagion via eating cooked pork, water sources, and insect bites were common. Respondents were unaware of transmissions via contaminated objects and droplets. Only 42.6% were satisfied with governmental efforts. Women were more likely to wash hands frequently than men (odds ratio 2.80, p < 0.001). CONCLUSION: There is a gap in swine flu knowledge, minimal risk reduction, increased amount of anxiety, and skepticism about swine flu vaccine safety. These gaps warrant serious attention to inform the public about specific actions regarding swine flu.